Staff-rated ability to provide post-diagnosis support for patients with mild cognitive impairment and related factors.

BACKGROUND: Proactive interventions for patients with mild cognitive impairment (MCI) are required. We aimed to determine the staff-rated ability to provide post-diagnosis support for patients with MCI at a medical centre for dementia and the related factors. METHODS: We conducted a web-based survey on post-diagnosis support for patients with MCI among healthcare personnel, such as mental health social workers and public health nurses (hereafter referred to as 'staff'), in consultation and support roles at medical centres for dementia nationwide. The latent characteristic value for 'staff's self-rated ability to provide post-diagnosis support to patients with MCI', which was estimated using the one-parameter logistic model of item response theory, was used as the dependent variable. Multivariate linear regression analysis was used to examine the factors associated with the dependent variable. RESULTS: We conducted the study at 482 medical centres for dementia. We received responses from 162 participants, 158 of which were valid. We applied item response theory to 45 staff-rated items regarding post-diagnosis support for patients with MCI and found that item difficulty ranged from -2.56 to 1.02; 40 items had negative values and were deemed relatively easy. The staff-rated ability to provide post-diagnosis support was significantly higher for 'The role in assisting patients with MCI is clear' (P < 0.005), 'A reasonable number of personnel is available to assist immediately after MCI diagnosis' (P = 0.001), and 'Collaboration with family physician available immediately after MCI diagnosis' (P < 0.001). CONCLUSIONS: The results of this study showed that staff rated their ability to provide post-diagnosis support for patients with MCI as relatively easy. The staff-rated ability to provide post-diagnosis support to patients with MCI may be enhanced by increased availability of staff immediately after MCI diagnosis, clarification of staff roles, and collaboration with family doctors.

[The relationship between burnout, personal traits, and the work environment of caregivers in group homes].

OBJECTIVES: This study aimed to identify the relationship between burnout, personal traits, work environment, and the stress coping skills of caregivers in group homes (GH) for elderly patients with dementia. METHODS: An anonymous, self-administered questionnaire was distributed to 600 caregivers working in 47 GH in Fukuoka Prefecture. Three hundred and thirty-three responses were analyzed. The questionnaire gathered information on burnout, personal traits, work environment, and stress coping skills. The modified Japanese version of the Maslach Burnout Inventory (MBI) was applied. RESULTS: The mean age of the subjects was 42.5 years. The 2 main employment statuses were full-time worker (75.4%) and temporary worker (22.8%). The annual income of 178 (53.5%) subjects was less than 2 million yen. Most of them (80%) harbored job insecurity with regard to the future. The mean scores for 3 MBI elements-emotional exhaustion, depersonalization, and reduced personal accomplishment-were 14.3, 11.2, and 16.1, respectively. After adjusting for personal traits and work environment, burnout was found to be significantly associated with the difficulties perceived by caregivers, and was composed of 4 factors: conflict with the GH residents, support system at the workplace, conflict among staff members, and a sense of being burdened. The elements of emotional exhaustion and depersonalization were also related to the subjects, while the element of reduced accomplishment was related to their active coping levels. CONCLUSION: The burnout status of caregivers in GH is associated with their perceived difficulties in daily care work. This finding suggests that these caregivers require individual support to cope with the difficulties involved in their daily care work as well as to improve their work environment.

[Difficulties faced by caregivers at group homes for elderly with dementia and related factors].

OBJECTIVES: To identify difficulties that caregivers at group homes for elderly with dementia (hereafter "GH") have in dealing with residents and related factors, and to study how to best provide support to GH caregivers. METHODS: An anonymous, self-administered questionnaire was distributed to 600 caregivers working at 47 GHs in "A" City, Fukuoka Prefecture. Analysis was conducted on 333 responses. The questionnaire consisted of 14 items for basic attributes and facility environments, and 27 items for difficulties caregivers perceive in dealing with the demented elderly. These 27 were derived from semi-structured interviews with 10 GH caregivers conducted in advance and their factor structure was determined by factor analysis. In addition, relationships of total subscale scores for each factor with basic attributes and facility environments were analyzed. RESULTS: The difficulties perceived by GH caregivers were subsumed into 4 categories, namely "conflict with the demented elderly," "support system at workplace," "conflict among staff members," and "sense of burden." The Cronbach's alphas of individual factors were found to be in the range from 0.75 to 0.82, confirming their internal consistency. The items significantly related to "conflict with the demented elderly" were anxiety for the future, care-giving experience, understanding the wishes of residents' families, and understanding the GH facility principles. The items significantly related to "support system at workplace" were thoughts of quitting their job and a cooperative system, while those for "conflict among staff members" were anxiety for the future, thoughts of quitting their job, a cooperative system, and information sharing. The items significantly related to "sense of burden" were anxiety for the future, thoughts of quitting their job, information sharing, and wishes regarding working schedule arrangements. CONCLUSION: The GH caregivers had various difficulties in dealing with the demented elderly. It became clear that, for alleviation of the difficulties caregivers perceive, the educational system needs to be improved to help the caregivers have better understanding of GH facility principles and the wishes of the residents' families. It was also clarified that organizational efforts to promote information sharing and a cooperative system among staff members, as well as to provide support to individual caregivers by addressing the difficulties encountered, are of great importance.

Association between the transition from unemployment to re-employment after abrupt bankruptcy and the depressive symptoms.

The study aimed to examine the effects of long-term unemployment and the transition from unemployment to re-employment after abrupt bankruptcy on the mental health of unemployed Japanese. The cases of 96 men and 54 women who were laid off by a large shoemaking company because of sudden bankruptcy in 1998, were examined for one year. The mental health of these individuals was evaluated using a 'self-rating questionnaire for depression (SRQ-D)'. The respondents were categorized by employment transition status into four groups: (1) still employed full-time, (2) unemployment to full-time employment, (3) unemployment to part-time employment, and (4) still unemployed. The prevalence rate of depressive symptoms in the 'still unemployed' group was significantly higher (adjusted odds ratio (OR) = 4.33) than in the still employed group. Moreover, high levels of depressive symptoms were observed in the individuals in the 'unemployment to part-time employment' group (adjusted OR = 4.93). There was no significant risk of depressive tendency among individuals in the 'unemployment to full-time employment' group. The results suggest that the negative effect of re-employment to part-time employment on depressive symptoms is similar to that in long-term unemployment.